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Source: Substance Abuse and Mental Health Services Administration. (2011).Results from the 2010 national survey on drug use and health: Summary of national findings. Rockville, MD: Author.

The following figure from Table 7.5 "Prevalence of Illegal Drug Use, Ages 18–20, 2010*" is striking: 47.1 percent of all Americans ages 12 and older have used an illegal drug at least once in their lifetimes. This percentage translates to almost 120 million people. In terms of lifetime use, the single most popular illegal drug is easily marijuana, but 30 percent of Americans, or 76 million people, have used an illegal drug other than marijuana. Almost 15 percent, or more than 37 million people, have used cocaine/crack or hallucinogens, and more than 20 percent, or almost 52 million people, have used prescription drugs illegally. These percentages and the numbers of people associated with them all indicate that lifetime illegal drug use in the United States is widespread.

Despite this fact, most public health experts are primarily concerned with current (past month) illegal drug use. The percentages for past-month (and also past-year) use in Table 7.5 "Prevalence of Illegal Drug Use, Ages 18–20, 2010*"are noticeably smaller than those for lifetime use. They indicate that most people who have used illegal drugs in their lifetimes are no longer using them, or at least have not used them in the past year or past month. Most of these lifetime users tried their illegal drug once, twice, or a few times and then stopped using it, and some may have used it more often but then stopped. In any event, it is the current, past-month users who raise the most concern for our society in general and for the public health and legal communities and other sectors of our society that deal with illegal drug use and its effects.

In looking at current illegal drug use, we see that 8.9 percent of the public falls into this category. This percentage translates to almost 23 million Americans, no small number by any means. Their favorite illegal drug is marijuana (and hashish), but 3.6 percent, or 9 million people, have used an illegal drug other than marijuana in the past month. These users favor prescription drugs used for nonmedical reasons. Despite the publicity that cocaine/crack still receives, less than 1 percent of the public has used it in the past month, and less than 2 percent has used it in the past year. These small percentages, though, still translate to 1.5 million people and 5.5 million people, respectively.

The percentages in Table 7.4 "Prevalence of Illegal Drug Use, Ages 12 and Older, 2010*" underestimate the problem of illegal drug use in at least two respects. First, the SAMHSA survey does not include people whose illegal drug use is especially high: the homeless, runaway teenagers, jail and prison inmates, and youths in detention centers. Second, and conversely, the SAMHSA survey includes people whose illegal drug use is relatively low—namely, young adolescents and people in their middle age and older years. For this reason, it is instructive to examine the prevalence of illegal drug use among the people who are in their “prime” ages for it: those who are 18–20 years old. Accordingly, Table 7.5 "Prevalence of Illegal Drug Use, Ages 18–20, 2010*" presents the appropriate figures for Americans in this age group.

Table 7.5 Prevalence of Illegal Drug Use, Ages 18–20, 2010*

	Lifetime	Past year	Past month
Any illegal drug	52.8	37.7	23.1
Illegal drug other than marijuana	31.2	19.1	8.0
Marijuana/hashish	46.4	32.7	20.3
Cocaine/crack	8.5	4.1	1.2
Hallucinogens	14.1	7.9	2.3
Heroin	1.6	0.5	0.2
Stimulants	7.8	3.9	1.3
Nonmedical use of prescription-type drugs†	24.5	14.5	5.9
* Percentage using in designated time period
† Includes stimulants

Source: Substance Abuse and Mental Health Services Administration. (2011).Results from the 2010 national survey on drug use and health: Summary of national findings. Rockville, MD: Author.

Take a moment to compare the percentages in Table 7.5 "Prevalence of Illegal Drug Use, Ages 18–20, 2010*" for ages 18–20 to the percentages in Table 7.4 "Prevalence of Illegal Drug Use, Ages 12 and Older, 2010*" for ages 12 and older. When you do this, you will see that past-year and past-month illegal drug use is generally much higher for people ages 18–20 than for everyone 12 and older. More than one-third of the 18–20 age group have used an illegal drug in the past year, and almost one-fourth are current users, having used an illegal drug in the past month. As with the 12 and older population, their drug of choice is clearly marijuana, with nonmedical use of prescription-type drugs a distant second.

This last statement is important to keep in mind. In terms of percentages, the major illegal drug is marijuana. Very low percentages of Americans use other illegal drugs when we consider current use and past-year use, although a greater number have experimented with other illegal drugs in their lifetimes. As we have seen, however, the low percentages for the other illegal drugs still translate into millions of Americans who are current users of illegal drugs other than marijuana. It is also true that drugs like heroin and cocaine/crack are used more heavily in large cities than in smaller cities and towns and rural areas. Although these drugs are only rarely used nationwide, they are a particular problem in large urban areas.

With this backdrop in mind, we now discuss a few illegal drugs in further detail.

Marijuana

As we have seen, marijuana is easily the most widely used illegal drug in the United States. The percentages for marijuana use in Table 7.4 "Prevalence of Illegal Drug Use, Ages 12 and Older, 2010*" translate to 106 million people who have ever used marijuana, 29 million people who used it in the past year, and 17 million people who used it in the past month (current users). As Table 7.5 "Prevalence of Illegal Drug Use, Ages 18–20, 2010*" showed, marijuana use is especially high among young people: One-third of people ages 18–20 have used marijuana in the past year, and one-fifth are current users.

Marijuana use can cause several problems (National Institute on Drug Abuse, 2010). ^[27] Marijuana distorts perception, impairs coordination, and can cause short-term memory loss, and people who are high from marijuana may be unable to safely drive a motor vehicle or operate machinery. In addition, regular pot smokers are at risk for respiratory problems, though not lung cancer. Chronic marijuana use is also associated with absence from school and the workplace and with social relationship problems, although it is difficult to determine whether marijuana is causing these effects or whether the association exists because someone with personal problems begins using marijuana regularly.

Despite these problems, marijuana is almost certainly the most benign illegal drug in terms of health and social consequences, and it is also much more benign than either alcohol or tobacco (Drug Policy Alliance, 2011; Faupel et al., 2010).^[28] As noted earlier, these latter two drugs kill about 520,000 Americans annually. In contrast, marijuana has probably never killed anyone, and its use has not been associated with any cancers. Alcohol use is a risk factor for violent behavior, but marijuana use is a risk factor for mellow behavior; if everyone who now uses alcohol instead smoked marijuana, our violent crime rate would probably drop significantly! Despite some popular beliefs, marijuana is generally not physiologically addictive, it does not reduce ambition and motivation, and it does not act as a “gateway drug” that leads to the use of more dangerous drugs (Hanson, Venturelli, & Fleckenstein, 2012). ^[29] A review of the evidence on marijuana summarized research findings as follows: “Studies of long-term marijuana smokers do not produce gross or major clinical, psychiatric, psychological, or social difference between users and nonusers, or between heavier and lighter users” (Goode, 2008, p. 247). ^[30]

While not entirely safe, then, marijuana is much safer, both on an individual basis and on a societal basis, than either alcohol or tobacco. Even so, it remains an illegal drug. This fact underscores our earlier observation that the legality or illegality of drugs has no logical basis. If the personal and social harm caused by a drug determined whether it is legal or not, then it would be logical for marijuana to be legal and for alcohol or tobacco to be illegal.

For better or worse, though, the millions of marijuana users have broken the law. In most states, marijuana possession is a crime punishable by a jail or prison term that depends on the amount of marijuana involved. Fourteen states (Alaska, California, Colorado, Connecticut, Maine, Massachusetts, Minnesota, Mississippi, Nebraska, Nevada, New York, North Carolina, Ohio, Oregon) have decriminalized simple possession of small amounts of marijuana: They treat possession as a minor offense similar to a traffic violation and punish it with only a small fine. Most of these states decriminalized the drug in the 1970s after a national commission with members appointed by the US Congress and by President Richard Nixon recommended taking this action. There is no evidence that marijuana use in these states increased compared to use in the states that have not decriminalized marijuana (Beckett & Herbert, 2008). ^[31] In fact, marijuana use in the nation declined sharply in the 1980s, the first decade after decriminalization began, both in the states that decriminalized pot possession and in the states that did not decriminalize it.

Cocaine

Cocaine produces a high that is considered more pleasurable than that for any other drug. According to sociologist Erich Goode (2008, p. 288) ^[32], “Cocaine’s principal effects are exhilaration, elation, and euphoria—voluptuous, joyous feelings accompanied by a sense of grandiosity.” As a stimulant, cocaine also increases energy, alertness, and a sense of self-confidence. It is not physiologically addictive, but it is considered psychologically addictive: The high it produces is so pleasurable that some users find they need to keep using it.

Cocaine is made from coca plants grown in South America. It most often appears in a powdered form that is sniffed (or, to use the more common term for this method, snorted). The high it produces takes some time to occur but may last up to thirty minutes once it does arrive. A more potent form, crack cocaine (or, more commonly, crack), is made by heating a mixture of powdered cocaine, baking soda, and water. A user then heats the mixture that remains and breathes in the vapors that result. Crack produces an immediate, intense high and is a relatively inexpensive drug. These features made crack a very popular drug when it was first introduced into US cities in the 1980s (Faupel et al. 2010). ^[33] Street gangs fought each other to control its distribution and sale, much as organized crime gangs fought each other over alcohol distribution and sale during Prohibition.

Cocaine and crack use has declined since the 1970s and 1980s, but, as Table 7.5 "Prevalence of Illegal Drug Use, Ages 18–20, 2010*" showed, almost 15 percent of the public has used cocaine at least once; this number translates to some 37 million Americans. Still, past-year use is only 1.8 percent, and past-month (current) use is only 0.6 percent. Cocaine use thus must be considered rare in percentage terms. At the same time, these percentages translate to 4.5 million and 1.5 million Americans, respectively. These are not small numbers. Moreover, past-year and past-month cocaine use is higher among young people, as Table 7.5 "Prevalence of Illegal Drug Use, Ages 18–20, 2010*" showed. Further, crack use remains a problem in the nation’s urban areas.

In terms of health risks, cocaine is a much more dangerous drug than marijuana. As a stimulant, cocaine speeds up the central nervous system. Because it does so much more intensely than most other stimulants, its use poses special dangers for the cardiovascular system (National Institute on Drug Abuse, 2011). ^[34] In particular, it can disrupt the heart’s normal rhythm and cause ventricular fibrillations, and it can speed up the heart and raise blood pressure. An overdose of cocaine can thus be deadly, and long-term use produces an increased risk of stroke, seizure, and heart disease. Because cocaine also constricts blood vessels in the brain, long-term use raises the risk of attention deficit, memory loss, and other cognitive problems. Long-term abuse has also caused panic attacks, paranoia, and even psychosis.

Heroin

Heroin is derived from opium (and more immediately from morphine, an opium derivative) and is almost certainly the most notorious opiate. It was one of the popular opiate drugs that, as discussed earlier, were used so widely during the late nineteenth century. Heroin was first marketed as a painkiller and cough suppressant by the company that makes Bayer aspirin. As the United States became more concerned about opium use, Bayer Laboratories discontinued heroin marketing in 1910, and heroin, like other opiates, was banned under the 1914 Harrison Narcotic Act.

Although Table 7.4 "Prevalence of Illegal Drug Use, Ages 12 and Older, 2010*"shows that its use is minuscule in percentage terms, these percentages translate to 600,000 people who have used heroin in the past year, and 240,000 who have used in the past month. Because these users are concentrated in the nation’s large cities, heroin, like crack, is a special problem for these areas.

Like other narcotics, heroin use produces a feeling of euphoria. After it is injected, “the user feels a flash, a rush, which has been described as an intense, voluptuous, orgasmlike sensation. Following this is the feeling of well-being, tranquility, ease, and calm, the sensation that everything in the user’s life is just fine. Tensions, worries, problems, the rough edges of life—all seem simply to melt away” (Goode, 2008, pp. 308–309). ^[35]

Although heroin use is uncommon, it continues to capture the public’s concern more than perhaps any other illegal drug. As sociologist Goode (2008, pp. 307–308) ^[36] has observed,

For decades, it was the most feared, the most dreaded, the “hardest” drug; heroin has virtually defined the drug problem. In spite of being somewhat overshadowed since the mid-1980s by cocaine, and specifically crack, heroin probably remains the single substance the American public is most likely to point to as an example of a dangerous drug. Until recently, disapproval of any level of heroin use was greater than for any other drug. And, until recently, heroin addicts were the most stigmatized of all drug users. Heroin is the epitome of the illicit street drug. Its association in the public mind with street crime, even today, is probably stronger than for any other drug. The stereotype of the junkie is that he or she is by nature a lowlife, an outcast, a “deviant,” a dweller in the underworld, an unsavory, untrustworthy character to be avoided at any cost.

Users typically take heroin into their body by injecting it into a vein. This mode of administration is undoubtedly a major reason for the public’s very negative image of heroin users. Indeed, the image of a heroin addict “shooting up” is one that has appeared in many movies and television shows past and present. Many heroin addicts share their needles, a practice that increases their risk of contracting HIV and hepatitis.

The public’s image and concern about heroin is partly deserved in some ways and partly undeserved in other ways. Like other opiates, heroin is extremely physiologically addictive, although not as addictive as nicotine. But also like other opiates, heroin does not damage body organs. The emaciated look we often associate with heroin users stems not from the drug itself but from the low-caliber lifestyles that heroin addicts tend to live and their decisions to spend the little money they have on heroin rather than on food and a healthier lifestyle. An overdose of heroin can certainly kill, just as overdoses of other drugs can kill. One reason heroin overdoses occur is that heroin users cannot know for sure the purity of the heroin they buy illegally and thus may inject an unsafe dose to get high.

Prescription Drug Abuse

Table 7.4 "Prevalence of Illegal Drug Use, Ages 12 and Older, 2010*" showed that about one-fifth of Americans have used prescription drugs for nonmedical purposes. This type of use is illegal. It constitutes the most widespread illegal drug use other than marijuana use and has grown in recent years, especially among adolescents. The prescription drugs that are most often abused are those containing narcotics, tranquilizers, and stimulants; two of the most common brands that are abused are OxyContin and Vicodin. Because prescription drugs are beneficial for so many people even if they are abused, our nation faces a special difficulty in dealing with the abuse of these drugs. As the head of the National Institute on Drug Abuse explains, “The challenges we face are much more complex because we need to address the needs of patients in pain, while protecting those at risk for substance use disorders” (Zuger, 2011, p. D1). ^[37]Thus according to a news report, “These drugs must be somehow legal and illegal, encouraged yet discouraged, tightly regulated yet easily available” (Zuger, 2011, p. D1). ^[38]

Most prescription drug abusers have their own prescriptions or obtain their drugs from friends, acquaintances, or relatives who have their own prescriptions. Whatever the source, some of these prescriptions are obtained legitimately—for actual medical conditions—and then abused, and some are obtained after feigning a medical condition. Many experts fault physicians for overprescribing painkillers and other prescription drugs.

Prescription drug abuse is thought to be growing for two reasons (National Institute on Drug Abuse, 2005). ^[39] First, physicians’ prescriptions for painkillers and other drugs continue to rise, creating a greater supply of prescription drugs that can be abused. Second, online pharmacies and pain clinics have made it easier to obtain prescription drugs, with or without an actual prescription.

The Note 7.14 "Applying Social Research" box discusses the roots of adolescent prescription drug abuse in family and school factors. The importance of these factors reinforces the sociological view that the origins of drug use often lie beyond the individual and in the social environment.
Applying Social Research

Prescription Drug Abuse by Adolescents

Despite the importance of prescription drug abuse, social science research on its causes is relatively sparse. In one of the first studies to examine the social origins of adolescent prescription drug abuse, sociologist Jason A. Ford analyzed data on adolescents in the national survey conducted by the Substance Abuse and Mental Health Services Administration that is discussed elsewhere in this chapter. Drawing on the large body of work that attributes drug use in part to weak social bonds, Ford reasoned that prescription drug abuse should be higher among adolescents who have weaker bonds to their parents and also weaker bonds to their schools.

For his measure of parental bonds, Ford used several questions that asked adolescents about their relationship with their parents, including whether parents feel proud of them and praise them for doing a good job, and whether their parents help them with their homework and limit their time out with friends on a school night. For his measure of school bonds, he used several questions that asked adolescents such things as whether they liked going to school and whether they found their schooling meaningful and important. His measure of prescription drug abuse relied on the adolescents’ self-reports of whether they had used any prescription drug for nonmedical purposes in the past year.

Controlling for gender, race, and other factors, Ford found support for his hypotheses: prescription drug abuse was higher among adolescents with weaker bonds to their parents and also weaker bonds to their schools.

These results have important implications for efforts to reduce prescription drug abuse by adolescents. They suggest that efforts by our society to strengthen families and to improve our schools may well have a significant, beneficial side-effect: lower prescription drug abuse by adolescents.

Source: Ford, 2009 ^[40]
KEY TAKEAWAYS

• 
  The distinction between legal drugs and illegal drugs has no logical basis; legal drugs cause much more harm than illegal drugs.
  
• 
  Alcohol and tobacco kill more than 500,000 Americans annually. Binge drinking on campuses results in accidents and assaults involving several hundred thousand college students annually.
  
• 
  Marijuana is by far the most commonly used illegal drug. The low prevalence of other illegal drugs still amounts to millions of people using these drugs annually.
  

FOR YOUR REVIEW

1. 
   Do you agree or disagree that the distinction between legal drugs and illegal drugs is not logical? Explain your answer.
   
2. 
   Do you agree that binge drinking is a problem that campuses should address, or do you think that it’s a relatively harmless activity that lets students have some fun? Explain your answer.
   

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[3] Mokdad, A. H., Marks, J. S., Stroup, D. F., & Gerberding, J. L. (2004). Actual causes of death in the United States, 2000. Journal of the American Medical Association, 291(10), 1238–1245.

[4] Frech, E. J., & Go, M. F. (2009). Treatment and Chemoprevention of NSAID-associated Gastrointestinal Complications. Therapeutics and Clinical Risk Management, 5, 65–73.

[5] Harvard School of Public Health. (2012). Alcohol: Balancing risks and benefits. Retrieved March 30, 2012, from http://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/alcohol-full-story/index.html.

[6] Harvard School of Public Health. (2012). Alcohol: Balancing risks and benefits. Retrieved March 30, 2012, from http://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/alcohol-full-story/index.html.

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[19] Substance Abuse and Mental Health Services Administration. (2008). Underage alcohol use among full-time college students. Retrieved September 20, 2011, fromhttp://oas.samhsa.gov/2k6/college/collegeUnderage.htm.

[20] Center for Science in the Public Interest. (2008). Binge drinking on college campuses. Retrieved September 20, 2011, from http://www.cspinet.org/booze/collfact1.htm; National Center on Addiction and Substance Abuse. (2007). Wasting the best and the brightest: Substance abuse at America’s colleges and universities. New York, NY: Author.

[21] King, B., Dube, S., Kaufmann, R., Shaw, L., & Pechacek, T. (2011). Vital signs: Current cigarette smoking among adults aged ≥18 years—United States, 2005–2010. Morbidity and Mortality Weekly Report, 60(35), 1207–1212.

[22] King, B., Dube, S., Kaufmann, R., Shaw, L., & Pechacek, T. (2011). Vital signs: Current cigarette smoking among adults aged ≥18 years—United States, 2005–2010. Morbidity and Mortality Weekly Report, 60(35), 1207–1212.

[23] Centers for Disease Control and Prevention. (2011). Economic facts about US tobacco production and use. Retrieved September 20, 2011, fromhttp://www.cdc.gov/tobacco/data_statistics/fact_sheets/economics/econ_facts/.

[24] Centers for Disease Control and Prevention. (2011). Economic facts about US tobacco production and use. Retrieved September 20, 2011, fromhttp://www.cdc.gov/tobacco/data_statistics/fact_sheets/economics/econ_facts/.

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[26] Martin, T. W. (2011, September 6). Fewer Americans are smoking, and those who do puff less. The Wall Street Journal. Retrieved fromhttp://blogs.wsj.com/health/2011/2009/2006/fewer-americans-are-smoking-and-those-who-do-puff-less/.

[27] National Institute on Drug Abuse. (2010). InfoFacts: Marijuana. Retrieved September 22, 2011, from http://www.nida.nih.gov/infofacts/marijuana.html.

[28] Drug Policy Alliance. (2011). Marijuana facts. Retrieved September 22, 2011, fromhttp://www.drugpolicy.org/facts/drug-facts/marijuana-facts; Faupel, C. E., Horowitz, A. M., & Weaver., G. S. (2010). The sociology of American drug use. New York, NY: Oxford University Press.

[29] Hanson, G. R., Venturelli, P. J., & Fleckenstein, A. E. (2012). Drugs and society (11th ed.). Burlington, MA: Jones & Bartlett.

[30] Goode, E. (2008). Drugs in American society (7th ed.). New York, NY: McGraw Hill.

[31] Beckett, K., & Herbert, S. (2008). The consequences and costs of marijuana prohibition. Seattle, WA: American Civil Liberties Union of Washington State.

[32] Goode, E. (2008). Drugs in American society (7th ed.). New York, NY: McGraw Hill.

[33] Faupel, C. E., Horowitz, A. M., & Weaver., G. S. (2010). The sociology of American drug use. New York, NY: Oxford University Press.

[34] National Institute on Drug Abuse. (2011). Cocaine: Abuse and addiction. Retrieved September 27, 2011, from http://www.nida.nih.gov/researchreports/cocaine/effects.html.

[35] Goode, E. (2008). Drugs in American society (7th ed.). New York, NY: McGraw Hill.

[36] Goode, E. (2008). Drugs in American society (7th ed.). New York, NY: McGraw Hill.

[37] Zuger, A. (2011, June 14). A general in the drug war. New York Times. p. D1.

[38] Zuger, A. (2011, June 14). A general in the drug war. New York Times, p. D1.

[39] National Institute on Drug Abuse. (2005). Prescription drugs: Abuse and addiction. Washington, DC: Author.

[40] Ford, J. A. (2009). Nonmedical Prescription Drug Use Among Adolescents: The Influence of Bonds to Family and School. Youth & Society, 40(3), 336–352.